Bone healing of severe acetabular defects after revision arthroplasty

Ullmark, Gösta; Sørensen, Jens Benn; Nilsson, Olle

doi:10.3109/17453670902947416

Cited by 36 publications

(26 citation statements)

References 18 publications

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“…In an in vitro study Board et al [3] found BNP-7 was released from the graft in proportion to the strain imposed, and suggested strain from vigorous graft impaction and postoperative load transformed bone allograft from osteoconductive to osteoinductive. Clinical studies using PET for evaluation of the spatial and temporal development of bone formation report that the impacted bone allograft had transformed to living bone in acetabular revision surgery [52]. Like in other series, radiolucent lines were quite infrequent in this series [46,48].…”

Section: Discussionmentioning

confidence: 79%

The Survival and Fate of Acetabular Reconstruction With Impaction Grafting for Large Defects

García-Cimbrelo

Cruz-Pardos

García-Rey

et al. 2010

Clinical Orthopaedics &Amp; Related Research

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Background Impaction bone grafting has been used for acetabular reconstruction in revision surgery. However, most series do not establish differences in survival in revisions with differing severity of bone loss. Questions/purposes We therefore determined (1) the survival rate for rerevision associated with varying degrees of bone loss; (2) the frequency with which bone graft resorption occurred; and (3) whether the reconstruction restored the anatomic center of rotation of the hip. Methods We retrospectively reviewed 165 patients (181 hips) who underwent rerevision for major bone loss. Using the classification of Paprosky et al. 98 hips had a Grade 3A defect and 83 a Grade 3B. We determined survival rates for revision and graft resorption. Cup position was determined measuring vertical and horizontal positions and the distance from the center of the prosthetic femoral head to the normal center of rotation of the hip in both groups according to Ranawat. The minimum followup until rerevision or the latest evaluation was 0.3 years months (mean, 7.5 years; range, 0.3-17.7 years). Results The survival rate for revision at 8 years was 84% (95% confidence interval: 61-100) for Grade 3A and 82% (95% confidence interval: 68-100) for Grade 3B. Twelve hips were rerevised. Seventeen grafts showed bone resorption. Acetabular cup position was anatomically restored in both Grades 3A and 3B. Conclusions The midterm results for impacted bone allograft and cemented all-polyethylene cups were similar in both Grade 3A and Grade 3B hips. Acetabular reconstruction allows anatomic positioning of the cups and is associated with a low rate of rerevision.

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Section: Discussionmentioning

confidence: 79%

The Survival and Fate of Acetabular Reconstruction With Impaction Grafting for Large Defects

García-Cimbrelo

Cruz-Pardos

García-Rey

et al. 2010

Clinical Orthopaedics &Amp; Related Research

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“…The impaction bone grafting (IBG) technique was introduced for use in the acetabulum by Slooff et al [35] and has proven to be effective in revision surgery. Different series have confirmed excellent results using this technique [10,30,32,33] and bone graft incorporation has been reported in histologic and positron emission tomography studies [2,4,28,31,34,37]. In a goat model of impacted allograft, Schimmel et al [28] showed complete incorporation of the allograft by 48 weeks.…”

Section: Introductionmentioning

confidence: 75%

THA Revisions Using Impaction Allografting With Mesh Is Durable for Medial but Not Lateral Acetabular Defects

García-Rey¹,

Madero

García-Cimbrelo³

2015

Clinical Orthopaedics &Amp; Related Research

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Background Most acetabular revisions are managed with cementless hemispherical or elliptical metal implants relying on bone ingrowth. Nonetheless, loss of acetabular bone stock and inability to achieve secure component fixation represent challenges in the setting of revision total hip arthroplasty. Impaction bone grafting (IBG) using allograft represents one option for treatment of this problem. However, cup migration and bone graft resorption are limitations when IBG is used for large segmental defects, and the precise role of IBG as well as the use of mesh (and the kinds of defects for which mesh does not work well) in this setting remains unknown.Questions/purposes We therefore evaluated patients undergoing acetabular revision surgery using IBG and a cemented cup in large bone defects to determine (1) the frequency with which the hip center could be restored in hips with Paprosky 3A and 3B defects and in hips with or without the use of metallic mesh during surgery; (2) survivorship of IBG acetabular-revision reconstructions in patients with severe Paprosky 3A and 3B defects; and (3) risk factors for failure of the reconstruction, including the use of mesh and defect severity (3A versus 3B). Methods Between 1997 and 2009, we performed 226 acetabular revisions using IBG. During that time, indications for using IBG in this setting included Paprosky 3A and 3B defects without pelvic discontinuity. Of these, 204 (90.2%) were available for followup at a minimum of 5 years (mean, 10 years; range, 5-17 years). There were 100 hips with an intraoperative bone defect of Paprosky 3A and 104 with a 3B. Medial or rim acetabular uncontained defects were treated with medial and/or lateral metallic mesh in 142 hips. We determined the postoperative radiological cup position and acetabular reconstruction of the hip center according to Ranawat in both groups. We assessed the appearance of cup loosening and the possible risk factors with regression analysis. Results Mean postoperative acetabular abduction angle and vertical, horizontal, and hip rotation center distances improved (p \ 0.001 in all parameters). Nine hips showed radiological loosening in the group with bone defect 3A and 16 in Group 3B. The survival rate for loosening at 15 years was 83% (95% confidence interval [CI], 71%-95%) for Group 3A and 73% (95% CI, 60%-84%) for Group 3B (p = 0.04). The survivorship for loosening when using mesh or not at 15 years was: no mesh 89% (95% CI, 74%-99%), medial mesh 85% (95% CI, 72%-97%), lateral mesh 80% (95% CI, 67%-91%), and medial and lateral meshes

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“…We were inspired by a study [10] quantifying blood perfusion and new bone in the allograft around revisions of total hip arthroplasty. The group has performed several PET [14,15,17] on orthopaedic patients and report the method to be sensitive to visualise osteonecrosis that cannot be seen on plain radiographs [16]. That study did not report technical problems as we had in this study, namely, failed PET scannings due to patient movement during scanning or technical problems affecting the data sampling.…”

Section: Discussionmentioning

confidence: 65%

Blood perfusion and bone formation before and after minimally invasive periacetabular osteotomy analysed by Positron Emission Tomography combined with Computed Tomography

Mechlenburg

Hermansen

Thillemann

et al. 2013

International Orthopaedics (SICOT)

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Purpose Sufficient blood perfusion is essential for successful bone healing after periacetabular osteotomy (PAO). The purpose of this study was to quantify blood perfusion and bone formation before and after PAO analysed by positron emission tomography (PET) combined with computed tomography (CT). Methods Twelve dysplastic patients (nine women) were included consecutively in the study and all were operated upon by the senior author (KS). Median age was 33 (23-55) years. Initially, two patients were PET scanned in a pilot study to test our models for calculation of the physiological parameters. The following ten patients had their hip joints PET/CT scanned immediately before PAO and three to four weeks after. Oxygen-15-water was used to quantify blood perfusion and Flourine-18-fluoride was used to produce quantitative images interpreted as new bone formation in the acetabular fragment. Results The blood perfusion of the operated acetabulum before surgery was 0.07±0.02 ml/min/ml, and after surgery 0.19±0.03 ml/min/ml (p=0.0003). Blood perfusion of the non-operated acetabulum was 0.07±0.02 ml/min/ml before PAO and 0.07±0.02 ml/min/ml after surgery (p=0.47). The fluoride-clearance per volume bone of the operated acetabulum was 0.02±0.01 ml/min/ml preoperatively, and 0.06± 0.01 ml/min/ml postoperatively (p = 0.0005). Fluorideclearance of the non-operated acetabulum was 0.01 ± 0.01 ml/min/ml before PAO and 0.02±0.01 ml/min/ml after PAO (p=0.49). Conclusion Blood perfusion and new bone formation increased significantly in the acetabular fragment. Thus, the results of this study do not support the concern about surgically damaged vascularity after PAO.

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Bone healing of severe acetabular defects after revision arthroplasty

Cited by 36 publications

References 18 publications

The Survival and Fate of Acetabular Reconstruction With Impaction Grafting for Large Defects

The Survival and Fate of Acetabular Reconstruction With Impaction Grafting for Large Defects

THA Revisions Using Impaction Allografting With Mesh Is Durable for Medial but Not Lateral Acetabular Defects

Blood perfusion and bone formation before and after minimally invasive periacetabular osteotomy analysed by Positron Emission Tomography combined with Computed Tomography

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